Successful treatment of eyebrow intradermal nevi by shearing combined with electrocautery and curettage:Two case reports

BACKGROUND An intradermal nevus is a common skin tumour,and the classical method of removal has a risk of recurrence and scarring.It is a challenge for dermatologists to treat eyebrow intradermal nevi quickly and efficiently.This study focused on investigating the efficacy and safety of shearing combined with electrocautery and curettage in the treatment of eyebrow intradermal nevi.CASE SUMMARY We describe two adult patients with eyebrow intradermal nevi treated by shearing combined with electrocautery and curettage.Both patients were followed up regularly after surgery.At follow-up,no recurrence of eyebrow intradermal nevus and no obvious scars or hypopigmentation were found in either patient.The results indicated that shearing combined with electrocautery and curettage could remove eyebrow intradermal nevus without side effects and confirmed the efficacy and safety of this modality for treating these skin lesions.CONCLUSION Shearing combined with electrocautery and curettage has superior merits,including simple operation,good cosmetic effects,and high patient satisfaction,presenting great application potential for treating intracutaneous nevus.

Hepatitis B vaccine by intradermal route in non responder patients:An update

Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus(HBV)infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90%of general population.Individuals who develop an antiHBs titer less than 10 mIU/mL after primary vaccination cycle are defined"no responders".Many factors could cause a non response to the HBV vaccination,such as administration of the vaccine in buttocks,impaired vaccine storage conditions,drug abuse,smoking,infections and obesity.Moreover there are some diseases,like chronic kidney disease,human immunodeficiency virus infection,chronic liver disease,celiac disease,thalassaemia,typeⅠdiabetes mellitus,down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects.To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection.Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route.This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients.A comprehensive review of the literature using PubMed database,with appropriate terms,was undertaken for articles in English published since 1983.The literature search was undertaken in September 2013.

One-dimensional microstructure-assisted intradermal and intracellular delivery

The advancement in the materials manufacturing at micrometer and nanometer scales has already enabled numerous applications in electronics, optics, chemistry, biology and medicine. Biomedical devices carrying micro-/nanostructures are currently being widely used in drug delivery, drug release, biosensing and therapy. New clinical methods for disease diagnosis and treatments are being developed enabled by nanotech no logy. One-dimensional (ID) structures are playi ng an importa nt role in the direct drug delivery both in vivo and ex vivo among various micro-/nanostructures. Here, in this paper, we reviewed recent progresses made on next-generation intradermal and intracellular delivery strategies and applications with focus on ID microstructure-based approaches.

Effect of intradermal needle at five-zang Back-Shu points on treatment of chronic fatigue syndrome

Objective:To observe the effect of intradermal needle therapy on back-shu points of five zang organs in treating chronic fatigue syndrome(CFS)and provide evidence for the usage of unilateral back-shu point.Methods:Patients were randomly divided into bilateral back-shu point group,unilateral back-shu point group and non-acupoint group,remove shedding cases,each group remaining 30 patients.In bilateral back-shu point group,both sides of back-shu points of five zang organs were selected.In unilateral back-shu point group,only one side was selected,left or right alternately.The location where non-acupoint group inserted by intradermal needles were outward from the back-shu points,left or right alternately.Fatigue Scale-14(FS-14)was used to evaluate the fatigue level and the scores’improvement of physical fatigue and mental fatigue revealed the therapeutic effect on body constituents and spirits of CFS patient.Results:After the 8-week intradermal needle therapy,the total effective rate was 83.33%in the bilateral back-shu point group,which was 76.67%in the unilateral back-shu point group and 50.00%in the non-acupoint group.The curative effects of the two groups whose back-shu points of five zang organs were inserted by intradermal needles were better than the non-acupoint group(P<0.05).There was no significant difference in clinical efficacy between the bilateral back-shu point group and the unilateral back-shu point group(P>0.05).There were statistical differences in FS-14 questionnaires including total,physical and mental scores between before and after the treatment in both the two back-shu point groups(P<0.05).Only the scores of total and physical fatigue in decreased in non-acupoint group(P<0.05),which means it couldn’t help to alleviate mental fatigue statistically(P>0.05).Conclusions:(1)The intradermal needle therapy on back-shu points of five zang organs for CFS has a satisfying clinical efficacy in curing tiredness.It can help to reduce both physical and mental fatigue for the patients.Hence,it can regulate both body constituents and spirits simultaneously.(2)Needling the unilateral acupoints can get similar clinical efficacy to the bilateral points.It reveals that we can cut cost by reducing the consumption of the amount of intradermal needles used on one side.(3)Both the groups of back-shu points get better clinical efficacy than the non-acupoint group dramatically.The reason of why the intradermal needle can treat CFS maybe that back-shu points of five zang organs can regulate the functions of five zang organs characteristically.

Treatment of Patients with Vitiligo by Intradermal Pricking of Vitiligenous Skin Using Sharp and Blunt Needle

Background: Vitiligo is a well known autoimmune disease, both cell mediated and humeral reaction are implicated in its etiopathogensis. Pricking of marginal pigmented of vitiligo skin to stimulate normal melanocytes to migrate into vitiligenous area and induce new melanogenesis and this is well known mechanism to induce repigmentation and supported by publications. Objective: To use needling technique by using blunt and sharp needle by doing pricking completely white vitiligo skin in order to stimulate residual melanocytes of basal layer and or the melanocytes of outer root sheath of hair follicles to proliferate and induce active melanogenesis. Patients and Methods: This is an interventional, therapeutic, comparative, study that was done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq from April 2014-March 2015. Thirty five patient with vitiligo were enrolled in this study, their ages ranged from 5 - 55 (22.28 ± 12.09) years;15 patients treated with sharp needle, 2 males and 13 females and 20 patients treated with blunt needle, 4 males and 16 females. All clinical types of vitiligo including the generalized, localized and segmental were treated. The number of vitiligo patches varied between patients and the treated patches by sharp needle were 22 and by blunted needle were 20 patches. In both groups, needling was done geometrically, softly and rapidly in systemic horizontal rows away from pigmented margin and pigmented spot inside the patches and was not repeated. In Group A needle gauge 18 hold at 45° to skin surface and the distance between each pricking was 5 - 10 mm and similarly was done in Group B by using blunt needle. Each patient was advised to have daily sun light exposure for at least 15 min. Measuring the surface area of the lesions and calculating the reduction rate was done by using transparent with square paper and this was carried out every month till the end of the 4th month period of the treatment. All patients in both groups were evaluated every 2 weeks for the 1st month and then monthly for 3 months and the rate of reduction in surface area was measured. Also to record any side effects and complications. Results: After 2 week, 2 months, and 4 months of treatment, there was 0.5%, 4.31%, and 10% respectively reduction in the surface area of lesions in Group A, while in Group B, there was 7%, 18.42%,and 13.5% respectively reduction in the surface area. Conclusions: Pricking the vitiligo skin by needle, gauge 18 gave success rate 10% and 13.5% at four months after therapy and needling could be repeated once a week to accelerate melanogenesis and until get complete repigmentation.

Intradermal Acupuncture on the Prevention and Adjuvant Treatment of Coronavirus Disease 2019

In view of the serious threat to people's health caused by the Coronavirus Disease 2019(COVID-19),according to the relevant spirit of the Notice on Establishing the Cooperation Mechanism of traditional Chinese and Western Medicine in the Prevention and Treatment of COVID-19 and other Infectious Diseases issued by the National Health Commission of the People's Republic of China,National Administration of Traditional Chinese Medicine of the People's Republic of China,on the basis of our early clinical research of using press needle embedding(intradermal acupuncture)to prevent and treat related diseases,the symptoms,etiology and pathogenesis of the disease were analyzed.We try to use the simple and easy intradermal acupuncture therapy to prevent and assist the treatment of the disease and its complications,hoping to make a modest contribution to help patients relieve part of suffering,and also provide advice for the doctors in the treatment of the disease.

Superior antibody and membrane protein‑specific T‑cell responses to CoronaVac by intradermal versus intramuscular routes in adolescents

Background Optimising the immunogenicity of COVID-19 vaccines to improve their protection against disease is necessary.Fractional dosing by intradermal(ID)administration has been shown to be equally immunogenic as intramuscular(IM)administration for several vaccines,but the immunogenicity of ID inactivated whole severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)at the full dose is unknown.This study(NCT04800133)investigated the superiority of antibody and T-cell responses of full-dose CoronaVac by ID over IM administration in adolescents.Methods Participants aged 11–17 years received two doses of IM or ID vaccine,followed by the 3rd dose 13–42 days later.Humoral and cellular immunogenicity outcomes were measured post-dose 2(IM-CC versus ID-CC)and post-dose 3(IMCCC versus ID-CCC).Doses 2 and 3 were administered to 173 and 104 adolescents,respectively.Results Spike protein(S)immunoglobulin G(IgG),S-receptor-binding domain(RBD)IgG,S IgG Fcγreceptor IIIa(FcγRIIIa)-binding,SNM[sum of individual(S),nucleocapsid protein(N),and membrane protein(M)peptide pool]-specific interleukin-2(IL-2)+CD4+,SNM-specific IL-2+CD8+,S-specific IL-2+CD8+,N-specific IL-2+CD4+,N-specific IL-2+CD8+and M-specific IL-2+CD4+responses fulfilled the superior and non-inferior criteria for ID-CC compared to IM-CC,whereas IgG avidity was inferior.For ID-CCC,S-RBD IgG,surrogate virus neutralisation test,90%plaque reduction neutralisation titre(PRNT90),PRNT50,S IgG avidity,S IgG FcγRIIIa-binding,M-specific IL-2+CD4+,interferon-γ+CD8+and IL-2+CD8+responses were superior and non-inferior to IM-CCC.The estimated vaccine efficacies were 49%,52%,66%and 79%for IM-CC,ID-CC,IM-CCC and ID-CCC,respectively.The ID groups reported more local,mild adverse reactions.Conclusion This is the first study to demonstrate superior antibody and M-specific T-cell responses by ID inactivated SARSCoV-2 vaccination and serves as the basis for future research to improve the immunogenicity of inactivated vaccines.

Intradermal fillers for minimally invasive treatment of facial aging

The ever-increasing interest in retaining a youthful physical appearance has facilitated the development of various minimally invasive dermatological techniques.The use of intradermal fillers can be incorporated into dermatological practices with minimal overhead costs.This strategy addresses facial volume loss and dynamic lines,which are the main features of facial aging.Moreover,intradermal fillers provide an array of flexible treatment options for a balanced and holistic result to dermatological practitioners.This paper reviews the different intradermal fillers categorized by biodegradable and non-permanent fillers including collagen based materials,hyaluronic acid and autologous fat,semi-permanent fillers including poly methyl methacrylate,poly-L-lactic acid and calcium hydroxyapatite microspheres,and permanent fillers including silicone.A discussion is provided of the commercial products made of these materials and their clinical efficacy in the treatment of facial aging.

Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine

Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed nonresponders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.

Immunizing Vulnerable Populations Like Rag Pickers, Garbage Collectors, Municipality Workers and Newspaper Hawkers against Rabies in Shimla Municipality, HP, India

Background: Rabies is a zoonotic disease and many vulnerable sections like rag pickers and municipality workers neglect animal bites due to ignorance of their potential deadly outcomes. Stray dogs abound in garbage pits and this population is exposed to their attacks. It should be a mandate for municipalities to help protect their sanitary workforce, especially rag pickers, from deadly infectious diseases such as Rabies, Hepatitis-B, HIV, Tetanus etc. Objectives: Objective of this study was to study methods to provide pre-exposure Rabies vaccination for such highly exposed populations by engaging them and understanding their perception of this disease through a constant dialogue with them. Methods: We started by engaging with the rag pickers to know how best to entice them to get themselves immunized. We then attempted to search literature for the most practical methods likely to succeed in reducing risk of rabies deaths in this population. Results: WHO approved 3 injections of 0.1 ml tissue culture vaccine on days 0, 7 and 21 were tried but were shown to result in many dropouts among rag pickers for repeat injections. We then followed a method where 0.1 ml of rabies vaccine was injected at 4 different anatomical sited in one setting. This proved acceptable and relatively inexpensive. A small number of subjects were studied by determination of neutralizing antibody by RFFIT, which proved immunogenic having anamnestic response on boosters given single IM or at 4 sites ID subsequently, implying that short schedule rabies pre-exposure vaccination can be done in high risk groups and may save lives if applied to the poorest that are highly exposed.

Brazilian vaccinia virus strains show a classical orthopoxvirus infection course and cross-protection

【正】Objectives:The purpose of this work was to study the infection course and cross-protection in mice after intradermal injection of Vaccinia virus(VACV) strain Western Reserve and three Brazilian VACV strains: Aracatuba,Muriae and BeAn58058 isolated from cow,human and rodent,respectively.Methods:Balb/c mice were inoculated by footpad and back scarification and daily monitored regarding lesion development and weight loss.To check cross protection after intradermal VACV inoculation,mice were subsequendy infected with different VACV strains and monitored to check lesion development.Serum neutralization assays were performed to check for the presence of antibodies against Orthopoxvirus.Results:After VACV intradermal inoculation the lesion development pattern was similar in mice infected with the different virus strains.By using the footpad scarification model,cross-protection among VACV strains was observed.Moreover,neutralizing antibodies against Orthopoxvirus were detected in sera from mice infected with all VACV strains.Conclusion:Although it was not possible to observe virulence differences among VACV strains isolated from cow,rodent and human using the murine model,this inoculation route showed to be an appropriated model to study lesions development since it mimics natural infections by VACV in nature.

Semi-Quantitative Histological Analysis of the Effect of Intense Pulsed Light (IPL) and Carbon Dioxide (CO₂) Intradermic Injection on Fibroblast and Collagen Proliferation in the Skin of Wistar Rats

Background: In recent years, so-called “non-ablative rejuvenation” has been carried out with the use of lasers or intense pulsed light (IPL) to stimulate collagen production by dermal fibroblasts. Intradermal infusion of CO2 stimulates fibroblasts and the synthesis of collagen and elastin, contributing to the retraction of the skin and tissue rejuvenation. Objectives: To evaluate the effects of IPL and the intradermal infusion of CO2 on fibroblast proliferation and collagen in the skin of female rats. Methods: Sixteen adult female Wistar rats were divided into two groups of eight animals. Group 1 underwent IPL and group 2 underwent intradermal CO2 infusion. There was a total of 8 weeks of treatment. We conducted a punch in each animal before any procedure (T0), another punch in the middle of treatment at 4 weeks post-procedure (T1) and a punch at the end of treatment at 8 weeks post-procedure (T2). The cells involved in inflammation, fibrosis and vascularization of the injured tissue by histopathology were analyzed. Results: There was statistically significant fibroblast proliferation and collagen proliferation noted when analyzing all 16 animals together and also when considering the two study groups separately. In both groups, the greatest proliferation of fibroblasts coincided with periods of increased collagen production. Conclusion: Both IPL and intradermal CO2 infusion stimulated fibroblast and collagen proliferation in the skin of the rats studied.

Assessment of a Case of Immediate-Type Allergy against Human Insulin in a Type 2 Diabetic Patient and Allergic Reactions to Human Insulin in Japan

We report a 64-year-old female patient with an insulin allergy. She was treated with a combination of oral antihistamines, topical hydrocortisone cream, and moisturizing agents, which resulted in the improvement of eczema and intense pruritus. To evaluate insulin allergy, intradermal skin tests were performed with several insulin agents for clinical use and 0.9% NaCl. Skin testing with semisynthetic human insulin resulted in local, immediate skin reactions such as itchy erythema and wheals. Furthermore, we analyzed our case and 25 Japanese cases of insulin allergy previously reported in the literature as far as we know. Interestingly, the number of male patients was approximately two times higher than that of female, and the insulin-specific IgE antibody test was positive in 21 patients. We should keep the possibility of human insulin allergy in mind and prepare for it when initiating human insulin therapy.

Success Story of a Low Cost Intra-Dermal Rabies Vaccination (IDRV) Clinic-Lessons Learnt over Five Years of 12,000 Patient Vaccinations “Without Failure” at DDU Hospital Shimla, Himachal Pradesh, India <br/>—“Saving a Drop of Rabies Vaccine and Immunoglobulins” 12 Innovations to Make Himachal Pradesh Rabies Free State by 2020

Background: Rabies is a dreaded disease and an estimated 55,000 people die of rabies every year. Himachal Pradesh is in the North bordering China and is predominantly rural and hilly. Villages are near forests, where wild reservoirs of rabies exist. Since health facilities are not accessible easily, we need to innovate on existing schedules of rabies vaccination keeping in view the compliance of the patients and affordability so as to give them the best possible option of treatment. In the year 2006 and 2007, we, at DDU Hospital Shimla, experienced a severe shortage of rabies vaccine and patients were running from pillar to post to fetch rabies vaccine. At the same time, we learnt that some of the patients died because either they were not able to purchase the vaccine, mostly because of its high cost, $35, or they ignored the animal bites and did not seek the treatment. Since last year, we have been experiencing non-availability of rabies immunoglobulins (RIGs) in the market and have to innovate new schedules and techniques to save lives of the patients. Methods: During shortage of rabies vaccine in 2008, we contemplated to start a low cost intra-dermal (ID) clinic so as to make rabies vaccine affordable as intramuscular (IM) vaccination cost five times more than ID vaccination. But, there were three main hurdles. One hurdle was the non-availability of rabies vaccine vials having written on them “For IM/ID use” and another hurdle was only fewer animal bite patients attending the DDU Hospital, sometimes only one or two per day, which was insufficient to open a vaccine vial and distribute among them. The third problem being faced was reluctance of the hospital doctors to prescribe ID vaccine as this was not the practice at higher teaching institutions, including medical colleges. We contacted a vaccine company and few vials labeled as “For IM/ID use” were sourced from Mumbai (1200 km away from here). We asked the Chief Medical Officer, Shimla district to write a letter to all health facilities around our Hospital to give first aid to animal bite patients and then refer them to DDU Hospital for vaccination. Now we were able to pool the patients and divide a single 1 ml vaccine vial among four patients. After continuous advocacy, our stress that WHO has given its approval for ID use of rabies vaccine and that subsequent approval has been granted by Government of India was enough for doctors to prescribe the vaccine as ID. Last Year, we got ethical approval to inject rabies Immunoglobulins (RIGs) only locally in and around the wound at times of scarcity of RIGs in the market. The subsequent follow up of patients proved life saving in crisis of shortage of RIGs. Due to shortage of RIGs we innovatively vaccinated people bitten by rabid dogs or people who had consumed rabid cow’s milk and followed them for outcome, apart from having Rabies Fluorescent Focus Inhibition Test (RFFIT) was done for few of the patiens for verification of protective titers. We innovated a technique of extraction of last drop of vaccine from the vial and also saved a drop of RIGs being used for test dose before giving RIGs to the patients. Results: The first low cost anti-rabies clinic was started on August 2, 2008 after long advocacy sessions with the authorities and the doctors. Since then, we have done many innovations based on local requirements and patients’ feedback and accessibility to treatment. We have given pre and post-exposure prophylaxis to more than 12,000 animal bite victims over more than five years period in this single clinic, saving lives as well as money without any failure even in difficult rabid animal bite cases. Our innovation helped us save the vaccine and immunoglobulins till the last drop. Conclusions: Innovative ways by health providers backed by extensive literature review and scientific evidence can help patients get low cost health deliverables that increase their compliance as medicines/vaccines become affordable to them. Third world countries need to innovate their own ways to solve their problems of scanty resources and find innovative solutions to conquer them, rather than looking elsewhere for solutions.

耳穴皮内针治疗失眠:随机对照试验

Objective:To compare whether there is clinical effects difference between intradermal needle at auricular acupoint and conventional acupuncture for insomnia.Methods:A total of 70 patients were randomly assigned into an intradermal needle group and an acupuncture group,35 patients in each group.Finally 34 patients completed the study in the intradermal group,32 patients completed validly in the acupuncture group.The patients in the intradermal needle group received intradermal needle therapy,in which the needle was imbedded subcutaneously at auricular acupoint:Shenmen(神门TF4),Pizhixia(皮质下AT4),Zhen(枕AT3),Xin(心CO15),and back-shu point:Ganshu(肝俞BL18),Xinshu(心俞BL15),Shenshu(肾俞BL23)and Pishu(脾俞BL20),as well as Anmian(安眠EX-HN18)retained for 2 days,and the patient would received a second therapy every other day,one course of treatment consisted of 3 times of treatment.The patients in the acupuncture group received a conventional acupuncture therapy,in which Zhaohai(照海KI6),Shenmai(申脉BL62),Shenmen(神门HT7),Sanyinjiao(三阴交SP6),EX-HN18,Sishencong(四神聪EX-HN1)were punctured conventionally with needle and the needle was retained for 30 min,once per day,one course of treatment consisted of 5 times of treatment.Before and after the4 courses of treatment,Pittsburgh sleep quality index(PSQI)of the patients in the two groups were evaluated,and their clinical therapeutic effects were evaluated too.Results:There were no statistically significant differences of PSQI scores and clinical therapeutic effects of the patients with insomnia in two groups after treatment(both P>0.05).Conclusions:Intradermal needle at auricular acupoint and conventional acupuncture therapy have comparable clinical therapeutic effects.

Differential fat harvesting

Aim:Volume replacement with fi llers is regularly performed with the use of diverse volumetric materials to correct different structures around the face,depending on the volume enhancement required and the thickness of the soft tissue envelope.Differential fat harvesting and posterior grafting is performed to place the correct fat parcel size for each target area,expanding the potential applications of fat.Methods:Sixty patients consecutively recruited on a fi rst come basis undergone a facial fat grafting procedure,in private practice setting between March 2012 and October 2013.Fat grafting quantity and quality was predicted for each case.Differential harvesting was performed,with 2 fat parcels size.Processing was performed through washing.Fat infi ltration was carried out through small cannulas or needles depending on the treated area.Outcomes were analysed both by the physicians and the patients at 7 days,1 month,3 months and 6 months through a perceived satisfaction questionnaire.Parameters considered were downtime or discomfort,skin benefi ts,volume restoration,reabsorption rate estimated and overall improvement.Results:Full facial differential fat grafting procedure lasted an average of 1.5-2.5 h.Average downtime was 3-4 days.Follow-up was performed to a minimum of 6 months.Both patient and physician overall satisfaction rates were mostly excellent.Adverse events like lumps or irregularities were not encountered.Conclusion:Differential fat harvesting and posterior grafting is a valid alternative,to expand the repertoire of fat use,allow a more homogeneous effect,reduce the potential complications,speed up the process,improve graft survival,and to enhance overall aesthetic outcome.